surgery and reconstruction in breast cancer Flashcards
name the types of surgery under the headings: breast conservation (4) mastectomy (2)
-lumpectomy
wide local excision
Wire guided local excision (in non-palpable disease)
oncoplastic breast conservation inc therapeutic mammoplasty
-traditional transverse
Skin sparing with immediate reconstruction
what is neoadjuvant treatment?
treatment given as a first step i.e. to shrink a tumour prior to treatment
chemo to achieve breast conservation?
Taxmen +/- Herceptin
neoadjuvant endocrine methods
aromatase inhibitors e.g. letrozole often more effective than tamoxifen so only in post men women
what is oncoplastic surgery?
“oncoplastic”: safe oncological (cancer) surgery while avoiding tissue deformity
Uses principles of cancer and plastic surgery to reshape breast contours at time of cancer resection
Types of oncoplastic breast conservation?
- therapeutic mammoplasty (large breast or large tumour and reshaping)
- volume replacement techniques (small breasts)
- delayed symmetrising e.g. augment, lipomodelling
Mastectomy
- what is a mastectomy?
- reconstruction options
-removal of all breast tissue, usually spares skin if immediate reconstruction
-implant only
latissimus dorsi pedicled flap +/- implant
Deep inferior epigastric artery perforator free flap
inferior gluteal artery perforator free flap
Immediate reconstruction
-goals?
Restore Symmetry: Volume Shape Position (including nipple) Compared to opposite breast Must Address: Volume Deficit Skin Deficit
types of reconstruction?
additional necessities?
immediate OR delayed
Implant based OR autologous
Implant based: tissue expander acellular dermal matrix implant De-epithelialised skin/implant LD/implant
Autologous:
Peddled LD flap (Latissimus Dorsi)
Pedicle TRAM (Transverse Rectus Abdominis Myocutaneous)
Free TRAM (Transverse Rectus Abdomens Myocutaneous)
DIEP flap (deep inferior epigastric perforators (DIEP), as well as the skin and fat connected to them)
S-GAP flap (superior gluteal artery perforator)
I-GAP flap (inferior gastric artery perforator)
-nipple reconstruction
lipomodelling
contralateral symmetrising
implant reconstruction
- problems with implant based reconstruction?
- methods
loss of implant due to infection
capsular contracture
implant rippling
implant migration
-2 stage implant reconstruction
1st stage- mastectomy and then creation of a sub muscular rocket with expander insertion
visit clinic 2weekly for expansion
change of expander to permanent implant
ADM implant
advantages of acellular dermal matrix (ADM)?
one stage better lower pole expansion reduced post op pain improved aesthetic outcome permanent implant used at 1st operation
Axillary surgery
- what should be carried out prior to surgery?
- types?
-pre operative axially staging via US =/- core biopsy sentinal node biopsy Axillary clearance Axillary radiotherapy
what does a sentinel node biopsy involve?
the injection of a radioisotope or blue dye into the lymphatics which are then taken up by the lymph nodes and nodes with tumour present can be identified
